TRASTUZUMAB INDUCED CARDIOTOXICITY

INTRODUCTION
Trastuzumab is approved for use as either a single agent or in combination with paclitaxel
in patients with metastatic breast cancers that over-express the HER2 protein. The reported
incidence of congestive heart failure with single-agent trastuzumab is 7% and rises to 11% when
trastuzumab is combined with paclitaxel. The highest incidence (28%) was noted when
trastuzumab was given with an anthracycline. In the randomized phase III study of trastuzumab
in combination with chemotherapy (doxorubicin plus cyclophosphamide or with paclitaxel), the
incidence of cardiac dysfunction was 28% in patients receiving trastuzumab plus doxorubicin
plus cyclophosphamide versus 7% for doxorubicin/cyclophosphamide alone and 11% in those
receiving trastuzumab plus paclitaxel versus 1% for paclitaxel alone. The incidence of classes III
and IV (New York Heart Association Classification) cardiac failure was 19% for
trastuzumab/doxorubicin/cyclophosphamide versus 3% for doxorubicin/cyclophosphamide and
4% for trastuzumab/paclitaxel versus 1% for paclitaxel alone.